In Georgia (Eurasia), A Parable of Contraception

The following report was filed by Haley Sweetland Edwards, a freelance writer living in Tbilisi, Georgia, and posted in an International Herald Tribune blog called Latitude: Views from Around the World. The story illuminates key aspects of the politics of reproductive health and provides compelling lessons in support of comprehensive reproductive health and reproductive rights.

TBILISI – Eka, a short brunette with brown eyes highlighted by green eyeliner, is by several measures the average Georgian woman. She has a high-school degree, a job, a husband, two children, and at age 30, has had, over the course of her eight years of married life, four abortions.

“It’s a reality in Georgia,” Eka told me over coffee on Wednesday. She said that “almost everyone” she knows has had at least two abortions.

Indeed, a 2005 survey on reproductive health in Georgia found that women here had on average 3.1 abortions in their lifetimes – a number that at the time earned Georgia the dubious honor of having the highest documented abortion rate in the world. (The rate in the United States today is .02.) The situation since then has improved considerably. According to a 2010 survey, Georgian women were having on average only 1.6 abortions in their lifetimes – a 48 percent decline over five years earlier.

Why the remarkable drop? The simple answer is that women in Georgia finally got the pill. That’s largely thanks to a campaign funded by U.S.A.I.D. and the United Nations Population Fund (U.N.F.P.A.) that educates doctors and nurses here, markets birth control on television and subsidizes the cost of condoms, pills and I.U.D.s.

This is a development success story that underscores a simple truth: more contraception equals fewer abortions.

But too often, still, myopic politics continue to stand in the way of that equation, endangering women in the process. Georgia’s current fertility rate – which is below replacement, despite a recent climb to two children per woman – is a hot political issue. Consequently, the government refuses to cover contraception in the state-funded healthcare program for the poor.

Denying poor women safe contraception won’t solve the problem of population decline, though; it will only encourage them to use abortion as a primary means of birth control, as they have done for decades. Right now, roughly 40 percent of Georgian women in rural areas wouldn’t be able to afford birth control ($9-12 per cycle) without the subsidies provided by the U.S.A.I.D.-U.N.F.P.A. program.

The issue is further complicated by the Orthodox Church, which wields enormous political power in Georgia. Family planning clinics, public health providers and international NGOs must walk a delicate line, and so they tend to promote contraception, which the Church condemns, as a means to reduce rates of abortion, which the Church condemns even more.